In its simplest form malnutrition can be defined as any nutritional imbalance[1] . It is an umbrella term for abnormal physiological condition, which is caused by inadequate, unbalanced or excessive consumption of macronutrients and micronutrients, meaning that one is either not getting enough food or the right kind of food for normal functions such as resisting disease, growing, and doing physical work [2][3][4][5] . Even though malnutrition can derive also from overconsumption or the food being eaten lacking nutritional value, malnutrition is often referring to undernutrition (1). Undernutrition is a bigger problem in developing countries, whereas other types of malnutrition are more common in developed countries (5).
Malnutrition is a severe public health problem, which has an impact on health care outcomes, mortality rates, and financial costs of health care all around the world (5). It is usually caused by abuse, neglect, famine, poverty, limited understanding of an ideal diet and disordered eating (4). Even though there is no universal consensus on how to diagnose malnutrition, some of the clinical characteristics of malnutrition include:
Insufficient food and nutrition intake compared with nutrition requirements
Weight loss over time
Loss of muscle mass
Fluid accumulation
Measurably diminished grip strength. (4)
Critique
Malnutrition as a term is in general regarded as a serious problem which leads to several negative physical effects, which can further impact for instance school performance (1), so the point of critique is not so much about the concept itself but instead how it is treated and of the imbalanced access to nutrition. There are roughly 800 million people affected by malnutrition in form of undernutrition of which clear majority is located in the developing countries [6] The problem is not only regarding the food aid provided by NGOs but also about the government practices in developing countries, such as selling out big part of maize crop reserve right before a massive food crisis [7] Another area of concern is that there is no consensus over how to define and diagnose malnutrition which affects directly how well those suffering from malnutrition can be treated (5).
Relation to Sustainable Development Goal (SDG)
Malnutrition is mostly related to the SDG 2: Zero hunger, given that one of the targets of goal 2 is to end all forms of malnutrition [8] , which directly opposes the overall problem with malnutrition. Again in this regard, it is not only about undernutrition but all forms of malnutrition including over-nutrition and food which does not contain enough nutritional value. In addition, malnutrition is linked to SDG 3: Good wealth and well-being, which addresses the problem of preventable deaths of newborn and children under 5 years of age (8). Malnutrition exposes to several diseases and the link works the other way around as well ([9] 5, 4, 2). Some estimations even suggest that nearly half of deaths in children under five is caused by malnutrition (2), which means that this is a crucial aspect for SDG3 as well.
Illustration of corporate praxis
Some believe that malnutrition as undernutrition can partially be treated with the help of food supplements (5). Plumpy'nut is one of most widely used product in humanitarian aid when it comes to the severe acute malnutrition and therapeutic feeding[10] . It has been developed by a public-private partnership of Nutriset and the French institute of development [11] . Plumpy'nut is a thick paste made out of peanuts, milk powder, sugar and vegetable oils and each individually wrapped portion of 92 grams contains 500 calories (11). There are several benefits of Plumpy'nut compared to previous therapeutical feeding methods and some of the advantages include:
Long shelf life (lasts for 2 years without refrigeration)
Children can consume it on their own
No preparation needed
Can be produced close the point of consumption
Individual packages makes it more difficult to share with the family (10, 9)
Therefore many say that Plumpy'nut has revolutionized the humanitarian towards malnutrition as also described in the video clip below. However the product has attracted some critique as well (10). First of all, the product can only provide a short-term fix without having an impact on the root causes of complex issue of malnutrition in developing countries (10). Second of all, some argue that humanitarian nutrition should not be patented, such as Nutriset patented Plumpy'nut, so that the aid can reach as many people as possible (11). In contrast, patent can also be regarded as an assurance of the quality of the product instead of merely protecting the business (11). Thirdly, there is not many unbiased (not in one way or another funded by Nutriset or Unicef) research available which would show the positive effects of Plumpy'nut. Some evidence, though, do exist of the product having a positive effect on gaining weight[12]
Another example of a product that is trying to fight against malnutrition is Shokti Doi yoghurt from Danone, which is filled with necessary micronutrients. It tries to complete the nutrition of the people Bangladesh with an affordable price level and simultaneously employ local people in the manufacturing and distribution. [13]
Malnutrition in Finland
In Finnish context, malnutrition is not as wide problem for the children as it is in developing countries but instead it is more apparent within the elderly people. Especially those who are staying long term in a nursing home are likely to be either suffering from malnutrition or having a great risk of being affected by it [14][15][16] . Some studies suggest that around 40% of the elderly people in Finnish nursing homes are suffering of malnutrition (15) while other research have resulted in 29 % (14).
The Finnish Government has addressed the malnutrition issue within the elderly people in order to guarantee that those who are in one way or another using the health care services receives enough support to maintain normal nutritional state even when the health condition can otherwise vary. One of the action taken to solve the issue was putting together nutritional suggestions for elderly people (Ravitsemussuositukset ikääntyneille), which discusses among other things what sort special factors should be taken into consideration with certain types of elderly people (dementia, living in nursing home), how the nursing people can ensure that the elderly patients are receiving enough nutrients and what types of services can help in the process. (16)
2. Pelletier, D., Frongillo, E., Schroeder, D. & Habicht, J. (1995). The effects of malnutrition on child mortality in developing countries. Bulletin of the World Health Organization, 73 (4), pp. 443-448. Available at: < https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2486780/pdf/bullwho00408-0029.pdf> Accessed: 21.4.2017.
3. Suominen, M., Muurinen, S., Routasalo, P. Soini, H., Suur-Uski, I., Peiponen, A., Finne-Soveri, H. & Pitkälä, K. (2005). Malnutrition and associated factors among aged residents in all nursing homes in Helsinki. European Journal of Clinical Nutrition, 59, pp. 578-583. Available at: < https://www.nature.com/ejcn/journal/v59/n4/pdf/1602111a.pdf> Accessed: 21.4.2017.
^ White, J., Guenter, P., Jensen, G., Malone, A. & Schofield, M. (2012). Consensus Statement: Academy of Nutrition and Dietetics and American Society of Parenteral and Enteral Nutrition: Characteristics Recommended for Identification and Documentation of Adult Malnutrition (Undernutrition). Journal of Parental and Enteral Nutrition, 36 (3), pp.275-283.
^ Food and Agriculture Organization of the United Nations (2015). The State of Food Insecurity in the World 2015. Available at: <http://www.fao.org/hunger/en/>, Accessed: 6.2.2017.
^ Skipper, A. (2012). Agreement of Defining Malnutrition, Journal of Parental and Enteral Nutrition, 36 (3), pp. 261-262.
^ Steiber, A., Hegazi, R., Herrera, M., Zamor, M., Chimanya, K., Pekcan, A., Redondo-Samin, D., Correia, M. & Ojwang, A. (2015). Spotlight on Global Malnutrition: A Continuing Challenge in the 21st Century. Journal of the Academy of Nutrition and Dietetics, 115 (8), pp. 1335-1341.
^ Pelletier, D., Frongillo, E., Schroeder, D. & Habicht, J. (1995). The effects of malnutrition on child mortality developing countries. Bulletin of the World Health Organization, 73 (4), pp. 443-448.
^ Scott-Smith, T. (2013). The Fetishism of Humanitarian Objects and the Management of Malnutrition in Emergencies, Third World Quarterly, 34 (5), pp. 913-928.
^ Yebyo, H., Kendall, C., Nigusse, D. & Lemma, W. (2013). Outpatient Therapeutic Feeding Program Outcomes and eterminants in Treatment of Severe Acute Malnutrition in Tigray, Northern Ethiopia: A Retrospective Cohort Study, Plos One, 8 (6), pp 1-9. Available: <http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0065840> Retrieved: 15.2.2017.
^ Suominen, M., Suurinen, S., Routasalo, P., Soini, H., Suur-Uski, I., Peiponen, A., Finne-Soveri, H. & Pitkälä, K. (2005), Malnutrition and associated factors among aged residents in all nursing homes in Helsinki. European Journal of Clinic Nutrition, 59, pp. 578-583. Available: < http://www.nature.com/ejcn/journal/v59/n4/pdf/1602111a.pdf> Accessed: 15.2.2017.
^ Suominen, M., Sandelin, E., Soini, H. & Pitkälä, K. (2009). How well do nurses recognize malnutrition in elderly patients? European Journal of Clinical Nutrition, 63, pp. 292-296. Available:
<http://www.nature.com/ejcn/journal/v63/n2/pdf/1602916a.pdf> Accessed: 15.2.2017.
Definition
In its simplest form malnutrition can be defined as any nutritional imbalance[1] . It is an umbrella term for abnormal physiological condition, which is caused by inadequate, unbalanced or excessive consumption of macronutrients and micronutrients, meaning that one is either not getting enough food or the right kind of food for normal functions such as resisting disease, growing, and doing physical work [2] [3] [4] [5] . Even though malnutrition can derive also from overconsumption or the food being eaten lacking nutritional value, malnutrition is often referring to undernutrition (1). Undernutrition is a bigger problem in developing countries, whereas other types of malnutrition are more common in developed countries (5).
Malnutrition is a severe public health problem, which has an impact on health care outcomes, mortality rates, and financial costs of health care all around the world (5). It is usually caused by abuse, neglect, famine, poverty, limited understanding of an ideal diet and disordered eating (4). Even though there is no universal consensus on how to diagnose malnutrition, some of the clinical characteristics of malnutrition include:
Critique
Malnutrition as a term is in general regarded as a serious problem which leads to several negative physical effects, which can further impact for instance school performance (1), so the point of critique is not so much about the concept itself but instead how it is treated and of the imbalanced access to nutrition. There are roughly 800 million people affected by malnutrition in form of undernutrition of which clear majority is located in the developing countries [6] The problem is not only regarding the food aid provided by NGOs but also about the government practices in developing countries, such as selling out big part of maize crop reserve right before a massive food crisis [7] Another area of concern is that there is no consensus over how to define and diagnose malnutrition which affects directly how well those suffering from malnutrition can be treated (5).
Relation to Sustainable Development Goal (SDG)
Malnutrition is mostly related to the SDG 2: Zero hunger, given that one of the targets of goal 2 is to end all forms of malnutrition [8] , which directly opposes the overall problem with malnutrition. Again in this regard, it is not only about undernutrition but all forms of malnutrition including over-nutrition and food which does not contain enough nutritional value. In addition, malnutrition is linked to SDG 3: Good wealth and well-being, which addresses the problem of preventable deaths of newborn and children under 5 years of age (8). Malnutrition exposes to several diseases and the link works the other way around as well ([9] 5, 4, 2). Some estimations even suggest that nearly half of deaths in children under five is caused by malnutrition (2), which means that this is a crucial aspect for SDG3 as well.
Illustration of corporate praxis
Some believe that malnutrition as undernutrition can partially be treated with the help of food supplements (5). Plumpy'nut is one of most widely used product in humanitarian aid when it comes to the severe acute malnutrition and therapeutic feeding[10] . It has been developed by a public-private partnership of Nutriset and the French institute of development [11] . Plumpy'nut is a thick paste made out of peanuts, milk powder, sugar and vegetable oils and each individually wrapped portion of 92 grams contains 500 calories (11). There are several benefits of Plumpy'nut compared to previous therapeutical feeding methods and some of the advantages include:
Therefore many say that Plumpy'nut has revolutionized the humanitarian towards malnutrition as also described in the video clip below. However the product has attracted some critique as well (10). First of all, the product can only provide a short-term fix without having an impact on the root causes of complex issue of malnutrition in developing countries (10). Second of all, some argue that humanitarian nutrition should not be patented, such as Nutriset patented Plumpy'nut, so that the aid can reach as many people as possible (11). In contrast, patent can also be regarded as an assurance of the quality of the product instead of merely protecting the business (11). Thirdly, there is not many unbiased (not in one way or another funded by Nutriset or Unicef) research available which would show the positive effects of Plumpy'nut. Some evidence, though, do exist of the product having a positive effect on gaining weight[12]
Another example of a product that is trying to fight against malnutrition is Shokti Doi yoghurt from Danone, which is filled with necessary micronutrients. It tries to complete the nutrition of the people Bangladesh with an affordable price level and simultaneously employ local people in the manufacturing and distribution. [13]
Malnutrition in Finland
In Finnish context, malnutrition is not as wide problem for the children as it is in developing countries but instead it is more apparent within the elderly people. Especially those who are staying long term in a nursing home are likely to be either suffering from malnutrition or having a great risk of being affected by it [14] [15] [16] . Some studies suggest that around 40% of the elderly people in Finnish nursing homes are suffering of malnutrition (15) while other research have resulted in 29 % (14).
The Finnish Government has addressed the malnutrition issue within the elderly people in order to guarantee that those who are in one way or another using the health care services receives enough support to maintain normal nutritional state even when the health condition can otherwise vary. One of the action taken to solve the issue was putting together nutritional suggestions for elderly people (Ravitsemussuositukset ikääntyneille), which discusses among other things what sort special factors should be taken into consideration with certain types of elderly people (dementia, living in nursing home), how the nursing people can ensure that the elderly patients are receiving enough nutrients and what types of services can help in the process. (16)
Open source articles
1. Isabel, M., Correia, T., Waitzberg, D. (2003). The impact of malnutrition on mobidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clinical Nutrition, 22 (3), pp. 235-239. Available at:
<https://www.researchgate.net/profile/Maria_Correia15/publication/10743702_The_impact_of_malnutrition_on_morbidity_mortality_length_of_hospital_stay_and_costs_evaluated_through_a_multivariate_model_analysis/links/0046351bae32015f85000000.pdf> Accessed: 21.4.2017.
2. Pelletier, D., Frongillo, E., Schroeder, D. & Habicht, J. (1995). The effects of malnutrition on child mortality in developing countries. Bulletin of the World Health Organization, 73 (4), pp. 443-448. Available at: <
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2486780/pdf/bullwho00408-0029.pdf> Accessed: 21.4.2017.
3. Suominen, M., Muurinen, S., Routasalo, P. Soini, H., Suur-Uski, I., Peiponen, A., Finne-Soveri, H. & Pitkälä, K. (2005). Malnutrition and associated factors among aged residents in all nursing homes in Helsinki. European Journal of Clinical Nutrition, 59, pp. 578-583. Available at: <
https://www.nature.com/ejcn/journal/v59/n4/pdf/1602111a.pdf> Accessed: 21.4.2017.
External links
Amsterdam initiative against malnutrition
World Health organization
MedlinePlus
Unicef
Action Against Hunger
Quiz
Quiz created by Mari Vesikivi with GoConqr
<https://www.wfp.org/hunger/malnutrition>, Accessed: 6.2.2017.
<https://pdfs.semanticscholar.org/6692/2fed041a68e2de1c1302ffbb926f8ed0409d.pdf>. Accessed: 15.2.2017.
<http://www.un.org/sustainabledevelopment/sustainable-development-goals/> Accessed: 6.2.2107.
<https://smartech.gatech.edu/handle/1853/36636> Accessed: 6.2.2017.
http://knowledge.essec.edu/en/sustainability/a-social-business-success-story.html> Accessed: 28.4.2017.
http://www.nature.com/ejcn/journal/v59/n4/pdf/1602111a.pdf> Accessed: 15.2.2017.
<http://www.nature.com/ejcn/journal/v63/n2/pdf/1602916a.pdf> Accessed: 15.2.2017.